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Management of low back pain in Australian emergency departments
  1. Giovanni E Ferreira1,
  2. Gustavo C Machado1,
  3. Christina Abdel Shaheed1,
  4. Chung-Wei Christine Lin1,
  5. Chris Needs2,
  6. James Edwards3,
  7. Rochelle Facer4,
  8. Eileen Rogan5,
  9. Bethan Richards1,2,
  10. Christopher G Maher1
  1. 1 Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia
  2. 2 Rheumatology Department, Institute of Rheumatology and Orthopaedics, Sydney, New South Wales, Australia
  3. 3 Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  4. 4 Emergency Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  5. 5 Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Giovanni E Ferreira, Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, NSW 2050, Australia; giovanni.ferreira{at}sydney.edu.au

Abstract

Background To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital; and to explore factors associated with these four outcomes.

Methods In this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs.

Results There were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51).

Conclusion Many ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.

  • emergency department
  • pain
  • health services research
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Footnotes

  • Contributors The corresponding author (GF) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This study has received a 2017 Kickstart Grant ($25,000) from Sydney Medical School, The University of Sydney

  • Competing interests C-WCL and CGM were investigators on the PRECISE study, an investigator-initiated trial evaluating pregabalin for sciatica, funded by the National Health and Medical Research Council of Australia with in-kind research support from Pfizer (ACTRN12613000530729). CN received fees for the provision of education seminars for the SHaPED trial, a stepped-wedge cluster randomised trial evaluating the implementation of a model of care for patients with low back pain presenting to emergency departments (ACTRN 12617001160325). All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval Research ethics and governance office Royal Prince Alfred Hospital (reference nos. X17-0419 and LNR/17/RPAH/631).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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